Shandong University of Traditional Chinese Medicine, Jinan, Shandong 250000, China.
Department of Neurosurgery, Shandong Provincial Hospital of Traditional Chinese Medicine, Jinan, Shandong 250000, China.
Clin Neurol Neurosurg. 2023 Nov;234:108006. doi: 10.1016/j.clineuro.2023.108006. Epub 2023 Oct 13.
Transradial access (TRA) provides a more direct entry to posterior circulation system for endovascular therapy compared to transfemoral access (TFA). This meta-analysis aims to evaluate the safety and feasibility of TRA in neurointervention of posterior circulation.
A systematic search was conducted in the Wanfang Data, CBM, PubMed, Embase, Cochrane Library, Web of Science databases. The primary outcomes included total complications and access site complications. Secondary outcomes were single puncture success, procedural success, access cross-over, catheter retention time and fluoroscopy time.
Six studies encompassing 297 patients were included in the meta-analysis. Compared to the TFA group, the TRA group showed significantly decreased total complications (odds ratio [OR] = 0.29, 95% confidence interval [CI] [0.12, 0.73], p < 0.01) and access site complications (OR = 0.19, 95%CI [0.06, 0.62], p < 0.01), yet it had a longer catheter retention time (mean difference [MD] = 0.80, 95%CI [0.60, 1.00], p < 0.01). There were no significant differences in single puncture success (OR = 3.68, 95%CI[0.38, 35.86], p = 0.26), procedural success (OR = 0.30，95%CI [0.05, 1.73], p = 0.18), access cross-over (OR = 2.29, 95%CI [0.19, 28.26], p = 0.52), fluoroscopy time (MD = 0.97, 95%CI [- 0.91, 2.84], p = 0.31) between the TRA and TFA groups.
This meta-analysis demonstrated that TRA is a safe and feasible alternative to TFA for neurointervention in the posterior circulation. TRA showed significantly decreased total complications and access site complications, yet it had a longer catheter retention time than TFA.
与经股动脉入路（TFA）相比，经桡动脉入路（TRA）为血管内治疗提供了更直接进入后循环系统的途径。本荟萃分析旨在评估 TRA 在治疗后循环神经介入中的安全性和可行性。
在万方数据、CBM、PubMed、Embase、Cochrane 图书馆、Web of Science 数据库中进行了系统检索。主要结局包括总并发症和入路部位并发症。次要结局包括单次穿刺成功率、操作成功率、入路交叉、导管留置时间和透视时间。
共有 6 项研究纳入 297 例患者进行荟萃分析。与 TFA 组相比，TRA 组总并发症显著降低（比值比[OR] = 0.29，95%置信区间[CI] [0.12, 0.73]，p < 0.01）和入路部位并发症（OR = 0.19，95%CI [0.06, 0.62]，p < 0.01），但导管留置时间更长（平均差[MD] = 0.80，95%CI [0.60, 1.00]，p < 0.01）。单次穿刺成功率（OR = 3.68，95%CI [0.38, 35.86]，p = 0.26）、操作成功率（OR = 0.30，95%CI [0.05, 1.73]，p = 0.18）、入路交叉（OR = 2.29，95%CI [0.19, 28.26]，p = 0.52）和透视时间（MD = 0.97，95%CI [- 0.91, 2.84]，p = 0.31）在 TRA 和 TFA 两组之间无显著差异。
本荟萃分析表明，TRA 是治疗后循环神经介入的一种安全可行的 TFA 替代方法。TRA 显著降低了总并发症和入路部位并发症的发生率，但导管留置时间比 TFA 长。
